Surely this is the worst part of being at the mercy of your own mind, especially when that mind lists toward the despondent at the first sign of gray: the fact that there is no way out of the reality of being you, a person who is forever noticing the grime on the bricks, the flaws in the friends — the sadness that runs under the skin of things, like blood, beginning as a trickle and ending up as a hemorrhage, staining everything. It is a sadness that no one seems to want to talk about in public, at cocktail-party sorts of places, not even in this Age of Indiscretion.

Much of her piece focuses on how she ended up at a psychiatric research hospital in New York City, on a unit housing depression patients and those with eating disorders. Her take on her eating disordered inmates was interesting. Merkin said this:

From the very first night, when sounds of conversation and laughter floated over from their group to the gloomy, near-silent table of depressives I had joined, I yearned to be one of them. Unlike our group, they were required to remain at lunch and dinner for a full half-hour, which of necessity created a more congenial atmosphere. No matter that one or two had been brought on to the floor on stretchers, as I was later informed, or that they were victims of a cruel, hard-to-treat disease with sometimes fatal implications; they still struck me as enviable. However heartbreakingly scrawny, they were all young (in their mid-20s or early 30s) and expectant; they talked about boyfriends and concerned parents, worked tirelessly on their “journaling” or on art projects when they weren’t participating in activities designed exclusively for them, including “self-esteem” and “body image.” They were clearly and poignantly victims of a culture that said you were too fat if you weren’t too thin and had taken this message to heart. No one could blame them for their condition or view it as a moral failure, which was what I suspected even the nurses of doing about us depressed patients. In the eyes of the world, they were suffering from a disease, and we were suffering from being intractably and disconsolately — and some might say self-indulgently — ourselves.

Except people with eating disorders are blamed for their illness, when it is even seen as an illness. Eating disorders are generally seen as some sort of failure--if not the sufferer, then clearly her parents. What else could create those fears of growing up? What else could create that pathological need for control? What else could make someone literally die to be thin?

Here's the thing, though. Both depression and eating disorders are illnesses. Sufferers are neither victims of society nor of themselves. They are victims of a frazzled brain, one that warps their perception of the world, that makes them hopeless and frightened. They need sympathy, not pity. Understanding, not blame.

I found it interesting both how and why Merkin found the ED patients "enviable." Some of it was clearly their youth, the hope and promise for the future. Some of it, too, might have been the visual reminder of the seriousness of their illness. I rarely felt I had the "right" to be sick because I didn't always look the part. Who could take my suffering seriously? How could I have an eating disorder? Depression, I would imagine, is the same way, with no outward confirmation of the internal struggle.

The essay is a haunting look at a lifetime of depression, and it resonated with me on many levels.

3 comments:

Anon Mom
said...

It's funny how it all comes down to filters and perspective. Sounds like the author was on the research floor at Columbia-Presbyterian/NYSPI, where I also have been a patient.

I felt just the opposite ... as though the staff could barely tolerate the idiocy of having to babysit people who practically starved themselves to death and might be squirreling away food in the pockets of their overalls; who had to be watched like hawks; who had irrational drama about nonsensical issues and might be prone to manipulation of weight, fluids, food, exercise, just about anything; and who, irritatingly enough, might have a medical/physical incident which would cause them to have to attend to us.

The people in the depression study seemed to have their own little club and actually seemed to be socializing among themselves (they also were sociable with those of us in the ED studies); didn't require the same kind of intense monitoring; didn't argue with staff about rules, "fairness," protocol, whatever; and ate without incident, taking their meds meant to help them (or recovering from ECT treatments) largely without incident.

There seemed concrete treatment plans for this group ... meds of some order, ECT, etc., which the patients seemed motivated to try and accept. We, on the other hand, largely had the treatment plan of eating a lot (food is your medicine) and bitching and moaning about it ... and b/c of research reasons, couldn't be on meds and may have benefitted from at least some kind of anti-anxiety prn.

We were demanding and needed groups and activities and interaction constantly, while the other study patients seemed less anxious and more self-directed ... and the floor staff definitely appreciated that much more.

They were there for treatment-resistant depression (or adolescent depression or a heroin addiction/detox study), but I felt a universal sense of expected treatment success and hope for them, while the prognosis for our ED study-group seemed steeped more in putting out temporary fires, which were bound to re-kindle ... this reinforced by most of having been in treatment programs many times before and having exhausted benefits, patience, or boundaries of said programs ... thus finding ourselves seeking free care under research auspices.

We were *not* the creative, cute&cuddle population of patients the excerpt seems to imply. Again ... all about perspective, I suppose.

Both your post and Anon Mom's comments are poignant to me especially today. My son took the first step toward voluntary hospitalization yesterday by calling for the pre-admission screen. I don't think I'm reassured by either perspective, frankly.

He is not sick enough for acute care hospitalization but he doesn't weigh enough to qualify for intensive outpatient programs. Carrie, yesterday's post about being high functioning despite your state of health hit home for our situation as well. He's plowing through his weeks at school doing very well, but at what price? I dread the perky "I'm fine" calls and emails because I know the voice of the disorder. His voice is the one that cries, "I'm exhausted. I want to come home."

The resident program we've found for him, the only one for males, is a four hour flight from home. They don't take urgent care, only voluntary admissions who 'fit' their program and are 'ready' to recover. ??? I guess they can boast of their success rate if they only admit patients they think will do well. But it's all we've got at this point and they are extremely supportive and kind by phone.

Time will tell I guess. We have to try. Oddly enough, it was hearing he didn't weigh enough for IOP that pushed him to accepting he needed to go into the other program.

My best friend is a Nurse Practitioner who, try as she might, does not get it, that he is not choosing to not eat. I can't get her to understand that is no such thing as 'good fats' to a person with anorexia. My son and I went to a NEDA meeting and it was such a relief for both of us. It was another push for him toward making that phone call yesterday.

That is much the same feeling I've gotten from nursing staff. One nurse referred to ED patients (I was admitted at that point primarily for depression, although AN was also on my rap sheet and I was being treated by the ED psychiatrist) as "cunning and devious." There were exceptions, staff who were wonderfully kind and caring, but there was also that resentment towards ED patients in general.

Sad Mom,

That's wonderful that your son took that step. I'm pretty sure I know the program you are talking about, and I hope that they can really help him move past this. I'm guessing your son is exhausted and he might not be able to admit that in so many words, but other things will give that away. Having a supportive mom/parent/caregiver is so important- your son is lucky to have you.

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About Me

I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.